title: Comparison of the performances of cardiac troponins, including sensitive assays, and copeptin in the diagnostic of acute myocardial infarction and long-term prognosis between women and men.
abstract: BACKGROUND
  Concerns have been raised about possible gender disparities in cardiac investigations and/or outcome. This study sought to examine and compare the diagnostic and prognostic performance of selected cardiac biomarkers in women versus men.
  
  
  METHODS
  In a prospective, multicenter cohort of patients with acute chest pain cardiac troponin T (cTnT) (fourth-generation Roche assay), high-sensitivity cTnT (hs-cTnT), and copeptin were measured at presentation.
  
  
  RESULTS
  Of 1,247 patients, 420 were women and 827 were men. Although the rate of acute myocardial infarction was similar in women (14.5%) and men (16.6%, P = .351), women more frequently had cardiac but noncoronary causes of chest pain (17.4% vs 10.8%, P = .001) and less frequently had unstable angina (8.8% vs 16.6%, P = .002) than men. Diagnostic accuracy as quantified by the area under the receiver operating characteristic curve (AUC) for acute myocardial infarction in women was 0.90 (95% CI 0.84-0.95) for cTnT, which was lower than the AUC for hs-cTnT alone (0.94, 95% CI [0.91-0.98]), the combination of cTnT with copeptin (0.96, 95% CI [0.94-0.98]) or the combination of hs-cTnT with copeptin (0.96, 95% CI [0.93-0.98]) (P = .008, P = .006, and P = .002, respectively). Prognostic accuracy as quantified by the AUCs for 1-year mortality was 0.69 (0.56-0.83), 0.86 (0.79-0.93), 0.87 (0.81-0.94), and 0.87 (0.80-0.94), respectively. No relevant gender differences in AUCs were observed.
  
  
  CONCLUSIONS
  The diagnostic and prognostic performance of cTnT, hs-cTnT, and copeptin is as good in women as in men. High-sensitivity cTnT and the combination of cTnT and copeptin outperform cTnT alone, both in women and men.
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Cathrin
authors.initials: C
authors.lastname: Balmelli
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Simone
authors.initials: S
authors.lastname: Rieder
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.forename: Maria Gimenez
authors.initials: MG
authors.lastname: Rubini
authors.forename: Tamina
authors.initials: T
authors.lastname: Mosimann
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.forename: Susanne
authors.initials: S
authors.lastname: Ernst
authors.forename: Paola
authors.initials: P
authors.lastname: Ballarino
authors.forename: Azza A
authors.initials: AA
authors.lastname: Alafify
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Carles
authors.initials: C
authors.lastname: Vilaplana
authors.forename: Denise
authors.initials: D
authors.lastname: Bernhard
authors.forename: Salome
authors.initials: S
authors.lastname: Merk
authors.forename: Stefan
authors.initials: S
authors.lastname: Ebmeyer
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D015203:Reproducibility of Results; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D020107:Troponin T / Q000097:blood*
chemical_list: D006020:Glycopeptides; D011498:Protein Precursors; D020107:Troponin T; C048197:copeptins